TOBACCO APPRENTICESHIP

APPLICATION FORM

2026 SPRING APPRENTICESHIP

JANUARY 31 - MAY 1

First Name *

Last Name *

Date of Birth *

Location *

Email *

Phone *

What is your intention for joining the Tobacco Apprenticeship? *

Are you currently working through any physical maladies? Bone breaks, surgeries, autoimmune disorders, gut issues, etc? *

Are you pregnant or breastfeeding? *

Please list your top 3 addictions, if any. *

Do you have any allergies? *

Have you had any recent surgeries? *

Do you currently take any medications? If so, please list: *

Have you ever had a mental health or mood disorder diagnosis? If yes, please describe. *

Have you ever been admitted to any form of inpatient mental health care? *

Do you regularly work with any herbal medicines, supplements or plant medicines? Please list. *

Day to day, how's your inner emotional universe? Calm, stormy, rollercoaster, numb, etc.

Have you had any major traumas in your life? *

Please describe your current understanding of shamanic Tobacco, as fully and thoroughly as you can. *

Have you worked with shamanic Tobacco before? In which forms & with who? *

What is your most significant critique or suspicion with shamanic culture and the plant medicine community? *

Can you describe your personal triggers? *

Briefly summarize your history & experience with shamanic plant medicine. *

What do you believe you will gain from joining this Apprenticeship? *

Anything else you would like to add or note for our facilitation team to consider?